Future directions for clinical psilocybin research: The relaxed symptom network.

Psilocybin-assisted psychotherapy may treat depression by weakening the connections between symptoms in a complex dynamic network, according to a theoretical model called the Relaxed Symptom Network. Drawing on the Network Theory of Mental Disorders, which views depression as an emergent phenomenon from strong symptom interactions, the authors propose that successful therapy reduces these connections, making patients less vulnerable to developing or relapsing into depression. The article summarizes clinical trials showing antidepressant effects of psilocybin when embedded in psychotherapy, reviews contested mechanisms, and offers practical guidance for integrating network theory into future clinical research.

Study at a glance

Abstract

Objective: Recent clinical trials have demonstrated that psilocybin may have strong antidepressant effects, and may be effective in the treatment of depressive disorders when embedded in a psychotherapeutic protocol (psilocybin-assisted psychotherapy; PAP). However, despite promising results, the mechanism(s) that may be responsible for the antidepressant effects of PAP remain contested. Within this article, it is argued that the ‘Network Theory of Mental Disorders’ may be a useful tool for clinical research with psilocybin, and may help elucidate the antidepressant elements of PAP. Method: The clinical research using PAP for depressive disorders is briefly summarised, as are the potential mechanisms of PAP. In addition to this, the fundamental tenets of the network theory is presented, with particular reference to depression. In brief, the network theory proposes that depression is an emergent phenomenon, due to strong interactions in a complex dynamic symptom network. Results: A model of action based on a symptom network is proposed. It is hypothesised that, if PAP is successful, the connections between symptoms in a network will weaken, thereby rendering the patient less vulnerable to developing/relapsing into depression. It is argued that the application of the network theory may ultimately improve responsiveness and reduce relapse in PAP. Practical guidance in using the network theory for future clinical research with psilocybin is also provided. Conclusion: This article presents the primary hypothesis of the authors (The Relaxed Symptom Network), and intends to inform future researchers on how to integrate the network theory with future clinical studies using PAP.